Patient oriented research (POR) must translate advances in basic and technical sciences into an increased understanding of disease processes and novel clinical applications that improve patient care. The investigator's long-term career goals are to - 1) encourage POR in gastroenterology;2) attract and mentor young trainees in POR;and 3) continually enhance his personal POR skills. The K24 mechanism has been instrumental in developing a POR program with a focus on Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Successful mentored research projects developed novel low cost methods for BE screening that were subsequently used to demonstrate familial aggregation of BE and EAC. K24 support has also allowed the investigator to mentor nine fellows and seven residents in numerous projects. Many have begun productive academic careers or gastroenterology fellowships. Enrollment in epidemiological and genetic courses has further enhanced the investigator's personal skills in POR. A new R01 project aimed at characterizing familial BE and the identification of the heritable genetic mutation(s) that determine susceptibility to Barrett's esophagus form the major basis of the investigator's ongoing POR program. Novel research investigating a potential link between obesity and BE through the insulin/IGF-1 pathway is proposed in this application. Renewed support will allow the investigator to meet his career goals by - 1) directing and growing POR activities within his division;2) continuing to attract and mentor residents, fellows, and advanced fellows in his expanding research program;and 3) continuing coursework in statistical genetics and cancer biology.